The News You Need for Feb. 12
Should Super Bowl Monday be a national holiday? We don't know about that, but we have some great news from WorkersCompensation.com to start your week right.
The Maze of Psychosocial Stress in Workplace Injury Recovery
Hartford, CT (WorkersCompensation.com) -- During the 20th Annual Workers Compensation Insurance ExecuSummit , Arnold Holzman , presented the impact of psychosocial stresses on recovery from workplace injuries. His session, "Impacting Psychosocial Stresses so Psychosocial Stress Don't Impact Recovery from Injury," aimed to explain how psychological factors intertwine with the physical aspects of injury healing. Dr. Holzman, an expert in psychology, emphasized the need for a comprehensive approach to injury care that addresses the underlying psychological dimensions in addition to the physical symptoms. His presentation included extensive research and experience, and he argued that psychological considerations should be integrated into treating and managing workplace injuries. This session highlighted the importance of treating the individual as a whole, and it provided strategies for addressing the complex interplay of mind and body in the recovery process, which is a significant shift in the industry's perspective.
Understanding Psychological Factors in Injury Recovery
Dr. Holzman began his presentation by emphasizing the significant role of psychological factors in the development, persistence, and healing of injuries. He drew inspiration from the ancient wisdom of Hippocrates, dating back to 400 BCE. Dr. Holzman highlighted the importance of understanding the individual experiencing the ailment rather than just focusing on it. This patient-centric approach, he argued, is crucial for effective treatment and recovery. Dr. Holzman's perspective aligns with the modern stance of the National Academy of Medicine, which advocates for a comprehensive approach to pain treatment. According to this approach, effective management of pain and injury recovery should encompass biological aspects and psychological and social components that influence an individual's health and well-being. By addressing these interconnected factors, healthcare providers can create a more holistic and effective patient recovery plan.
Overcoming Mind-Body Dualism
During his presentation, Dr. Holzman discussed the traditional approach in medicine that divides the mind and body, especially in the context of injury recovery. He criticized this perspective for labeling patients with prolonged recovery periods as having a 'psychological overlay,' implying that their physical symptoms are influenced or exaggerated by psychological factors. Dr. Holzman challenged this view by questioning how psychological factors can aid recovery. He pointed out the example of lumbar fusion surgeries, where, despite 84% of patients showing radiographic success, about half of them still express dissatisfaction with the outcomes. According to Dr. Holzman, this disparity highlights the insufficiency of relying only on physical indicators for successful treatment, emphasizing the need for a more integrated approach that considers both the physical and psychological aspects of pain and recovery.
The Role of Stress and Biopsychosocial Factors
During his presentation, Dr. Holzman focused on stress and its role in injury recovery. He explained that stress is not a passive event that happens to patients but an active process that involves external pressures and intrinsic responses. Dr. Holzman discussed the biopsychosocial model, which includes various psychological elements such as depression, anxiety, hostility, and substance abuse that can impact an individual's ability to recover from an injury. He also highlighted characterological factors, such as chronic maladjustment or symptom dependency, and cognitive aspects, like negative beliefs about symptoms or catastrophic thinking. Dr. Holzman emphasized that these biopsychosocial factors work together, often complicating the healing process and requiring a more comprehensive approach to treatment and rehabilitation.
Impact of Past Traumas
In his insightful discussion, Dr. Holzman discussed the impact of past traumas on medical outcomes in adulthood, particularly those experienced during childhood. He referred to a study that revealed a strong correlation between childhood psychological traumas and the success rates of lumbar spine surgeries. The study found that patients who had experienced multiple traumas during childhood had a high incidence of unsuccessful outcomes following lumbar spine surgery, reaching up to 85%. In contrast, patients who did not have a history of such traumas had a significantly lower incidence of unsuccessful surgery, only 5%. This disparity highlights the crucial link between past psychological experiences and physical health outcomes. Dr. Holzman emphasized that healthcare professionals should consider a patient's psychological and emotional history when planning and executing treatment, especially in cases involving significant surgical interventions.
Implications of Biopsychosocial Assessment
Dr. Holzman highlighted the limitations of traditional medical diagnostic techniques in his presentation. He pointed out that while these techniques effectively identify objective somatic (physical) conditions, they often need to be more comprehensive in fully capturing the complexity of pain and injury recovery. Dr. Holzman emphasized the need to revise these techniques to evaluate pain's subjective experience, understand the injury's broader context, and assess critical psychological aspects such as mood, attitudes, and motivation. To address this, he suggested adopting a biopsychosocial approach to assessment and treatment, which integrates these often-overlooked psychological and social factors with the physical aspects of the injury. Dr. Holzman recommended interventions to encourage behavioral changes, including reducing medication dependency, increasing the patient's activity levels, and actively supporting returning to work. By incorporating these elements into the treatment plan, healthcare providers can more effectively address the comprehensive needs of patients, leading to more successful recovery outcomes and an improved quality of life post-injury.
Applying Biopsychosocial Factors
Dr. Holzman discussed the crucial role of cognitive and emotional factors in the biopsychosocial patient care model. He emphasized that a patient's beliefs, expectations, and attitudes towards their health and healthcare system can significantly impact their emotional responses and, therefore, their recovery process. For instance, patients who hold negative beliefs about the effectiveness of their treatment or have pessimistic expectations about their recovery may experience heightened emotional distress, which can negatively affect their physical healing. Dr. Holzman also highlighted the significant influence of anxiety, explaining how it can worsen pain behaviors by causing patients to avoid activities that trigger pain or by increasing their sympathetic and musculoskeletal arousal. He suggested interventions sensitive to these emotional and cognitive aspects to address these issues effectively, emphasizing the need to approach such concerns with empathy and without stigma. By doing so, healthcare providers can create a more supportive and understanding environment, leading to better patient outcomes.
Maximizing Positive Outcomes Through Biopsychosocial Intervention
During his presentation, Dr. Holzman emphasized the importance of considering psychosocial factors in the early stages of treatment to improve recovery outcomes. He highlighted that treatment interventions should focus on the physical aspect of injuries and include psychological and social elements that can significantly influence a patient's healing process. Dr. Holzman also presented Cognitive Behavioral Therapy (CBT) as an example of a successful biopsychosocial intervention. CBT is known for its effectiveness in addressing not just the physical symptoms of an injury but also the accompanying psychological challenges such as reduced activity levels, negative and catastrophic thoughts, overall psychological distress, anxiety, and depression. CBT helps patients modify unhelpful thinking patterns and encourages more constructive behavior using techniques like cognitive restructuring and behavioral activation. This approach addresses the comprehensive spectrum of factors that can hinder or facilitate recovery.
Early Assessment and Intervention
During his presentation, Dr. Holzman stressed the importance of conducting early assessments to identify psychosocial risk factors that may hinder injury recovery. He recommended the timely implementation of customized interventions to address the identified factors, emphasizing that early intervention can significantly improve treatment outcomes. Dr. Holzman described several crucial strategies integral to this early intervention approach. He recommended patient education as critical in helping individuals understand their condition and the recovery process, thereby reducing anxiety and promoting a more proactive approach to their health. He also emphasized the effectiveness of motivational interviewing, a technique for patients to express and resolve their ambivalence about recovery, which creates a more positive attitude towards treatment. Pain coping strategies and behavioral activation were also noted as essential tools. These methods assist patients in developing skills to manage their pain more effectively and engage in activities that can improve their mood and aid in recovery, thus addressing their injury's physical and psychological aspects.
Employer’s Impact on Recovery
Employers play a critical role in the recovery process of injured workers. Dr. Holzman emphasized that employers are responsible for both the physical aspects of the workplace and the psychological environment, both of which can significantly impact an employee's health and recovery. Dr. Holzman stressed the importance of proactive measures by employers to prevent workplace stress, which could lead to psychological distress and exacerbate injury recovery. He suggested that employers create a supportive and understanding work environment, actively working to reduce conflicts and misunderstandings that could hinder an employee's recovery process.
Employers must be flexible and open-minded in facilitating return-to-work options for injured employees. Dr. Holzman suggested exploring creative and unconventional solutions that accommodate returning workers' specific needs and limitations, fostering a more inclusive and supportive workplace. Additionally, Dr. Holzman warned against actions or attitudes from employers that might create feelings of hatred, neglect, or isolation among injured workers. He stressed that feeling valued and supported by their employer is crucial for employees during their recovery and return-to-work process. Through such supportive actions, employers can not only aid in the physical recovery of their employees but also contribute positively to their overall morale and psychological well-being, both of which are essential components of a successful return to work.
During his concluding remarks, Dr. Holzman made a passionate plea for a change in how we approach workplace injuries. He emphasized the need for a comprehensive and holistic treatment strategy that addresses the physical, psychological, and social aspects of an individual's path to wellness. Dr. Holzman inspired his audience to view injury recovery as a complete and transformative healing journey considering the whole person- body, mind, and spirit. He urged healthcare professionals, employers, and policymakers to adopt this integrative approach, recognizing that proper recovery requires a balance and harmony of all aspects of human health.
Reports Raise Worker Safety Concerns at ADM
Decatur, IL (WorkersCompensation.com) - Reports from advocacy groups have raised concerns about worker safety at ADM after a series of accidents.
According to CU-Citizens Access, not only have OSHA investigations shined a light on safety incidents at the plant, but a look at open records requests by the investigative newsroom found that OSHA investigations only reported on a small number of incidents at the facility.
Between January 2023 and October 2023, CU-Citizen Access found, emergency medical services and local fire departments were dispatched to the plant nearly 70 times. Emergency medical services were called to the plant 51 times for everything from employees falling and breaking their legs to employees passing out or having a stroke. Fire crews were called 13 times for fire-related incidents, the report found.?
In one incident, the report found, just months before retirement on April 11, 2023, 66-year-old Robert Dautel was killed in an accident at the railyard in Decatur, Ill. Dautel was in a locomotive operated remotely by a trainee. Dautel was crushed when the locomotive hit a line of 25 stationary rail cars. An OSHA report into the incident found that the rail cars were placed too far forward the day of the incident, and OSHA found that ADM failed to provide an environment free of hazards that could cause death or serious injury.
In 2023, OSHA investigated conditions at the plant five times because of accidents that resulted in an employee’s injury or death, and has fined the company nearly $350,000 for six violations.
Most of those violations stem from an explosion in April.
On April 20, just nine days after Dautel’s death, an explosion in a grain elevator sent three employees to the hospital. OSHA’s investigation into the explosion resulted in a more than $320,000 penalty.
In an Oct. 18 report, OSHA found that ADM’s lack of preventative maintenance for the suppression system of a bucket elevator was a leading factor in the explosion. Inspectors said the suppression system on the indoor bucket elevator leg was non-functional and in a state of disrepair. Additionally, the investigators found, the grain processing facility had not conducted inspections or testing of the explosion suppression systems since 2016.
OSHA cited ADM for two willful violations, as well as on serious violation and one other-than-serious violation, and assessed a $328,796 in penalties.
"ADM knows the important role maintenance and testing plays in protecting the lives and health of their workers and their property from two previous explosions and yet failed to follow common industry practices and Occupational Safety and Health Administration standards to maintain these protective systems," said OSHA Area Director Edward Marshall in Peoria, Illinois. "Agriculture dust can explode in mere seconds when an ignition source is readily available. Dispersion of the dust particles can lead to rapid combustion known as deflagration. It causes explosions, worker injuries and extensive damage, as we saw in this case."
Previously, OSHA had cited ADM for not inspecting and testing critical safety systems in 2019 after an explosion in November 2018 at the company’s East Campus. In that incident, ADM agreed to conduct and document preventative maintenance on safety control equipment and to follow inspection procedures.
And in January 2019, an explosion and deflagration propagation event caused equipment and structural damage in the East Wet Milling Corn Plant, resulting in a detailed Hazard Alert Letter issued by OSHA to the company about equipment maintenance of explosion suppression and other systems.
In April, OSHA noted in a press release that the agency had an open inspection at ADM’s East Plant after another explosion and fire injured eight workers on Sept. 10, 2023, ad that the agency had issued citations to ADM on Sept. 29, 2023 after Dautel’s death. That investigation resulted in penalties totaling $15,625.
CU-Citizen Access also found that police responded to the plant in Decatur four times for life-threatening injuries. In one of those incidents, the victim had burns of 40 percent of his body surface, burns to his airways and swelling and soot around his nasal cavities, while another victim had burns over 30 percent of their body surface and possible damage to their airways.
Other incidents over the past 15 years, the CU-Citizen Access report found, included at least three other deaths and four employee injuries at the Decatur plant. Among those: a May 17, 2018 incident where an employee suffered multiple fractures to his skull, ribs, cheek and more when he was struck in the head by a filter which caused him to fall approximately six feet; a March 6, 2017 incident where an employee feel down an elevator shaft; and a Feb. 10, 2008 incident where two employees were killed from carbon monoxide poisoning.
A business agent with the Teamsters Local 916 told CU-Citizen Access that while its members typically work in the facility’s power plant, the union’s members have noticed that severe injuries routinely occur in other parts of the plant. He called it “safety by convenience.”
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“The company claims to be a very safety-oriented company, but when employees and members of the union bring concerns to them, nothing gets done,” he said.
Form Focus: N.Y. Carrier’s Request for Reconsideration of Reduction
Albany, NY (WorkersCompensation.com) -- When an insurer seeks a reconsideration in New York, there's a form for that. It's the C-251.6.
Here's how it works.
Certifications
When a carrier submits a C-251.6 it certifies that:
1. The amount of reimbursement requested is the same as that which was expended.
2. All payments were made in accordance with the applicable medical fee schedule and Medical Treatment Guidelines
3. No part has previously been reimbursed.
4. The amount stated is due and owing.
5. The information is true and correct.
Submission Information
Insurer ID (W Number). The WCB-assigned Insurer Code ("W Number") for the insurer that is responsible for the claim and seeking reimbursement; this entity must be identified as a Party of Interest (POI) on the claim in the WCB case folder in order for reimbursement to be processed.
Insurer Name. The form will populate the name of the insurer that is responsible for the claim and seeking reimbursement from the name in Groups tab.
Claim Administrator. The name of the entity that is administering the claim and will receive the reimbursement or indicate if claim is self-administered; this entity must be identified as a POI on the claim in the WCB case folder in order for reimbursement to be processed. Payment will be directed to the address the WCB Special Funds Group has on file for the administrator.
Contact Name. Enter the name of the person that the WCB Special Funds Group can contact with questions about the submission.
Phone Number. The phone number for the contact.
Email Address. The email address for the contact.
Submit Date. The date the form was submitted to the WCB Special Funds Group.
Claim Information
WCB Case Number. The claim number assigned by WCB; this number should be entered as it appears in eCase with no spaces or extra characters.
Claim Admin Claim Number (optional). The claim number assigned by the entity that is administering the claim.
Claimant Name. The name of the claimant.
Request SummaryReference Number. The reference number assigned to the original request by Special Funds Group. This number appears on Form C-251R and Form C-251.1R.
Begin Date. The begin date of the original request.
End Date. The end date of the original request.
Original Amount. The amount of the original request.
Requested Amount. The amount that reconsideration is being requested for; this amount cannot be greater than the difference between the amount of the original request and the amount that was approved by Special Funds Group for that request.
Instructions for Making the Request
Provide a brief statement of the particular grounds upon which the request for reconsideration is based. A one-page document may be attached as an addendum, using 12-point font, with 1-inch margins, on 8.5-inch by 11-inch paper. An addendum longer than one page will not be considered, unless the insurer specifies in writing, why the basis of the request could not have been made within the space provided and the one-page addendum. Additional supporting evidence may be submitted if such evidence has not been submitted previously and is not already available for consideration in the Board's electronic case folder. The number of additional documents submitted shall not exceed the number of medical bills at issue and/or, more than 10 pages where the request involves indemnity reimbursement.
Integrix Becomes Bronze Associate Partner of WorkCompCollege.com
Lakewood Ranch, FL – WorkCompCollege.com, a division of Workers’ Compensation Educational Services, LLC and an #Edutech Company, has announced a Bronze Associate Partnership with Integrix. The mission of WorkCompCollege.com closely aligns with the founding principles of Integrix of Improving Outcomes and Changing Lives. Partners whose corporate values match are always more effective.
“Nurse case managers are uniquely positioned to positively affect the outcomes for employees who are injured at work, while assisting employers and carriers achieve significant cost savings” says Alecia Roy, Integrix’s founder and president. “Nurses bridge the gap between medicine and the business of workers’ compensation. As we continue to grow along the Gulf Coast and the U.S. we are excited to partner with WorkCompCollege to help broaden our understanding of the specific statutes governing each state and jurisdictions in which we practice.”
Mark 'RxProfessor' Pew , Provost of WorkCompCollege, says, “A comment by Alecia in our initial discussion resonated deeply: Our industry is long overdue in centering professional development on the noble purpose of workers’ compensation. Our premise is that individuals who understand the big picture will make better choices. We cannot be more pleased to have Integrix join our mission of driving better outcomes to result in better communities and a better world.”
Leaders in the workers’ compensation industry have long been calling for better ways to maintain engagement of injured while managing claims.?Different names and phrases have been used to define this idea – workers’ recovery, advocacy-based claims management, bio-psychosocial adoption, whole-person care – but all center around the same critical realization: Treating & caring for the entire person. The key to this approach is developing an understanding of the injured employee’s psychology and thought process, and employing clear, concise, and consistent communication methods. This process is regarded as a better way to improve clinical outcomes while reducing friction and cost and restoring humanity to the process.
WorkCompCollege.com is a community-driven effort designed to address those needs and will help continue the trend toward lower costs and improved results through education, information exchange, and mentorship.
Educational services include the Workers’ Recovery Professional (WRP) and WRP Associate certification programs, a State-Specific Training Program and the Advanced Training & Education Center (ATEC). Current students and graduates represent every stakeholder in the work comp ecosystem throughout the United States. People interested in learning more can visit?www.WorkCompCollege.com.
About Integrix Integrix is a boutique-quality Case Management, UR and Field Investigation/Outside Adjuster services organization focused on facilitating a rapid progression of claims to closure through education, advocacy, out-of-the-box thinking, and a proactive approach to challenges. With a knowledgeable team of nurses and claims handlers, Integrix takes a proactive approach to getting injured workers’ back to work, while closing claims – the right way. From improving access to high quality and appropriate care to preventing unnecessary litigation, they advocate for the best possible outcome with a goal of expediting recovery while containing overall claim costs. For more information about Integrix, visit?www.itgxcorp.com.
About WorkCompCollege.com WorkCompCollege.com is a community-driven effort to improve the workers’ compensation industry through comprehensive education infused with a whole-person recovery management mindset. Their flagship offering, the Workers’ Recovery Professional (WRP) certification, is comprised of meaningful curriculum in nine schools: Claims, General Studies, Humanities, Legal, Medical Management, Regulatory/Legislative, Return to Work, Risk Management and Stakeholders. Other unique certifications and educational services are available as well. A diverse, talented team of School Deans and Faculty deliver the content in an asynchronous virtual campus environment. A service of Workers’ Compensation Educational Services, LLC this educational platform is a truly community driven effort revolutionizing how all stakeholders within the ecosystem become more proficient, professional and passionate about their role in an injured employee’s journey to return-to-work. To learn more please go to?www.WorkCompCollege.com?or e-Mail?[email protected].